Electronic prescribing (e-Prescribing), and the foundation standards that support it, will have a significant and wide ranging impact on the long term care (LTC) industry, which serves approximately 3.5 million residents in 17,000 skilled nursing facilities (SNF) across the United States. However, there is very little data available that illustrate the effects e-Prescribing will have on LTC. Therefore, it is critical that the Centers for Medicare & Medicaid Services (CMS) study e-Prescribing in an LTC setting. The Achieve Healthcare Technologies team proposes a pilot study to cover the range of standards referenced in the Request For Applications, with a specific focus on the nuances and unique complexities of the LTC environment. The Achieve pilot study will involve all necessary stake holder types, including LTC providers, institutional pharmacies, software solution vendors, and Pharmacy Benefits Managers (PBMs). Team members for the pilot study were selected based on their "thought leadership" in the industry, including leading and participating in the ongoing development of e-Prescribing standards for LTC. Furthermore, the pilot will leverage existing operational and organizational infrastructure to complete the study in the aggressive time frame. To ensure the study will result in actionable conclusions, the study will examine two geographically diverse treatment nursing facilities where the e-Prescribing standards will be implemented and two comparison facilities using traditional prescribing methods. The standards will be implemented in three distinct phases, allowing their impact to be independently and incrementally studied. The effect on workflow between prescribers, nurses, pharmacy and payers related to these standards will be documented in a final report to be delivered to CMS at the conclusion of the study.